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Another day in the life of a middle aged peasant

Update: Medical students, cardiopulmonary specialists, and heart patients, this is an actual post written while I was having what was later diagnosed by a cardiologist as a relatively ‘mild’ heart attack. Bear in mind no heart attack is truly mild in any sense of the word. Read below, learn what NOT to do when having symptoms.

So I’m having the usual holiday AS flare up, it seems to get worse in December like clockwork every year. And yesterday afternoon there’s a new worrisome symptom: chest pain! It was kinda behind the sternum, seemed to be in the base of the throat a little bit. It wasn’t debilitating but given my age, 50, and general risk behaviors, eating crap and smoking, not to mention constant high blood pressure and high blood fats, I’m a prime candidate for an MI and this could be a warning sign. To complicate matters, I also used to suffer from chronic panic attacks, so last night was real fun.

As in laying awake all night terrified to fall asleep and waking myself up every time the sand man knocked. It’s hard to say if it got worse, but it seemed like it might have a little bit. Finally at dawn I figured, what the hey, I have insurance, really good insurance in fact, I’ll just saunter on down to the ER and have this checked out. This is where you readers in civilized countries will need to stop and understand; going to the ER in the states, even with great coverage, is an expensive proposition and a bit of a gamble. For starters my copay is 250 bucks, all kinds of services have a knack for falling through the insurance grid and landing on one’s credit, and if it turns out not to be life threatening the insurance company can actually deny coverage. For an EKG and xray in the ER read by a cardiologist that could easily add up to thousands and thousands of dollars.

It hurt and it hurt in the right places, but it didn’t hurt real bad. There was no cold sweat or vomiting, no pressure sensation, the pain didn’t shoot into the arms or jaw, there was no trouble breathing, I didn’t even feel particularly panicky. It also happens I’ve lost 40 pounds and gotten my sorry ass in decent shape over the last year. Hell, a couple of weeks ago I ran 10 miles. But if you read the intertoobz it’s not hard to find examples of even younger people in way better shape having sudden death massive heart attacks.

What to do?

At 6 AM this morning I got in the car and headed off to the ER. On the way there was a grocery store and I needed some cash. The drug section was on the way to the ATM, so I happened to stop, buy some antacids and prilosec, chowed down some chalky tablets and popped a pill in the car. I was literally pulling into a local hospital ten minutes later when the it became clear the symptoms had noticeably backed off.

What to do? The smart move would have been to go in any way. But the reality here in the US is we are held hostage by rapacious health insurance companies and they would be well within their rights to screw me royally if this turned out to be a false alarm. Over the last hour the symptoms have mostly gone away, there’s still some pain behind the sternum, but not as bad, and now there’s also a dull burn in the pit of my stomach.

I’m going with the scientific method. The suite of initial symptoms better fits heartburn/ulcer, it’s the time of year when richer fattier foods are consumed (And believe me, I have been consuming them all week), the ‘test’ for heartburn or ulcer, i.e. antacics and acid blockers was positive, and on top of that a quick search on the Internet suggests people with rheumatoid disorders are more prone to gastrointestinal issues anyway.

Now it’s just a matter of trying to get into see my PCP today and hoping I won’t be penalized for missing a day of work after being up all night suffering from a possible heart attack, and taking some time today to recover and get some medical advice about it. Because my employer proudly advertises they penalize anyone — as long it’s someone in my low paid powerless position, different rules for others of course — for missing time no matter what the reason. Doesn’t matter if you’re in ICU or hung over in bed.

That’s just another day in the life of a peasant in the US healthcare system and the great American workplace.

This is the kind of worry that plagued Canadians in the 1930s. Ever American family should have its own letter campaign to all of its representatives demanding universal public non-profit health insurance until they get the message and implement it.

I had a very similar scare about two years ago: the diagnosis was that my heart was fine but my gall badder… not so much. Alas, that is a problem that runs in both sides of the family and will probably result in surgery before I’m 55. Joy.

What I was told by the ER doctor was that the typical heart attack is a crushing pressure in the center of the chest, leaving you barely able to breath (not always, but that is by far the most common manifestation in men.) If the pain is slightly to one side, if you are able to stand and walk around, then it probably is not your heart.

And yeah, health care in the US sucks big time. I don’t see the Insurance for Insurance Companies Act doing much to mitigate the problems, either.

I’m north of the 49th parallel and as such enjoy the benefits of universal health care and think it is well past time that our neighbours to the south enjoyed a similar system.

However, with the privilege of universal heath care also come the responsibility to use the system wisely.

Do you think that you are really a “peasant in the US healthcare system” ?

Are you completely a victim here ?

Is there nothing you can do to control your own destiny ?

I happen to be in the same demographic as you, 57 year old white male with a history of heart disease in the family and I would consider it unethical to pursue life style choices that would further burden an already maxed out health care system.

So, the symptoms you describe are classic GERD. Gastroesophageal reflux.

How to tell the difference between GERD and a heart attack? Drink a class of water. The symptoms should ease up considerably if you drink water and it’s GERD. If not, then not GERD.

However, if you’re concerned, it’s better to get checked out than not get checked out.

Anecdotes are not data, but I have three.

1. My brother was complaining to his GP about some discomfort he was having 7 minutes into his elliptical routine. 7 minutes like clockwork. He was already scheduled for hernia surgery, but she had him go to a cardiologist. Despite having no history, good numbers otherwise, and a clean ECG, they cathed him. Found two blockages. One fairly recently. And he recalled having ENORMOUS heartburn a few months ago while on vacation. Wasn’t heartburn. Was a heart attack.

2. Friend of mine and I were in a rehearsal. He was complaining of a chest cold. Coughing, looked pale. He waxed and waned a little through the night, but made it through. Then went home and his heart stopped beating. He had just enough time to yell “Call 911″ to his wife. Turned out, he was having a massive heart attack the whole time we were together. He didn’t make it. He died a couple weeks later.

3. I have an arrhythmia. My chest hurts all the time — but I deal. The other day, got a “new” pain. I was sure this was “it”. Went to the ER and got checked out. Wasn’t anything other than my usual.

I can feel the whole thing now, from the base of my throat right into the pit of my stomach in one linear shot. Not only do I not want to lay down, it makes it worse. Whereas sitting or standing up causes almost immediate relief. The OTC meds seem to be working really well, I can barely feel it now.

But yes, I’m going to get checked out anyway, heart and GI both, it”s time for a stress test at least, I wish I could get a cath because that’s really the only way to know for sure, but I doubt that’ll get approved.

#4, yes you are correct. But in my defense I have been on a consistent training program for months, I am in better shape than my coworkers half my age and better shape than I;ve been in for decade. Cigs are addictive, one can only do so much so fast, but I am going to talk to my PCP about the most effective way way to quit regardless of what turns up. FYI I feel like a peasant because I don’t earn much and it doesn’t seem to matter how hard I work, I’ve fallen squarely out of the middle class over the last several years. It’s been an eye opening experience.

I also have autoimmune issues and the meds that I have to take for that have added to the GERD that comes along with Sjogren’s. I take a Prilosec daily, and if I try to get off of those, it gets worse. I truly understand about the scary symptoms in the chest. I usually just wait to see if the pain moves down, proving that it’s “just” heartburn.
Like you, I have decent insurance, but the tests that the docs usually want aren’t fully paid for by the insurance, so we wind up with a bill that we can’t afford. The scary thing is that someday that pain won’t turn out to be “just” heartburn.
Those of us with AI issues really need to have good comprehensive healthcare. That’s why I’m an advocate for universal healthcare.

I understand from friends who were smokers that there are prescription drugs available that can help with the smoking addiction. I don’t have the details, but I’m sure your PCP will be able to give you the info.

I think crowd sourcing here tomorrow is worth it. There have to be readers who have quit, I’m curious how they did it, how many times it took, etc. A patch or gum or something sound like the best way to go for me, but I really don’t know much about it.

One of the best medications to help stop smoking is chantix, I believe that has pretty good statistics for quitting smoking. It can be expensive, but most insurers pick up part of the cost. The patches have abysmal success data as well as less to no insurance co-pay. As far as your chest pain, generally speaking if movement makes it worse, or eating or drinking water makes it lessen it is probably not cardiac. That said, any time you have chest pain that is unrelieved for any period of time get it checked out. Make reasonable changes to improve your health, no one picked their genetic makeup and family history is the best predictor of risk.

Also, if you live near an urgent care clinic the out of pocket can be a fraction of the cost. Many large hospitals run an urgent care as part of their ER. Tell the Dr. upfront that cost is an issue, and they can pare things down to the most important. Having worked in medical for many, many years I rarely saw anyone that had no bad habits or always made the best health choices. It sounds like you are taking the steps to optimize your situation already. Auto-immune issues affect everything.

As well as the good advice in didgen’s post, how’s your blood sugar? You’re at a good age for type 2 diabetes to set in and that can really mess up a lot of things including your cardio-vascular system. Bloodwork is indicated in any case – it can show if you’ve had an MI. An MI is not necessarily indicated by crushing chest pain and inability to breathe. Some have little or no marked symptoms. If you have a PCP go see her/him. Seems time for a good checkup anyway. Good luck!

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[…] this with Darksyde: he felt chest pains, found that they eased with antacids and prilosec, and figured it was just heartburn, and so skipped going in to the doctor. Wrong move! It turns out he actually had a heart attack (a fact that gives Christians and […]

[…] my heart attack for February, heart health month. For patients, docs and emergency responders can read this post, written when I was actually having a full blown, massive myocardial infarction. Below is a rough […]